Insurance Terms

A

The present-day value of property measured in cash, arrived at by taking the replacement cost and deducting for depreciation brought about by physical wear and tear and obsolescence.

Actuary

A person concerned with the application of probability and statistical theories to the practical problems of insurance and related fields. Actuarial responsibilities extend to the calculation of premiums, evaluation of various reserves, forecasting of financial results on both a long-range and a short-range basis.

Additional insured

A person, other than the one in whose name an insurance policy is written, who is protected against loss by terms of the policy.

Agent

A representative of the insurer in negotiating, servicing or effecting insurance contracts.

Aggregate

The maximum limit of liability payable by an insurance carrier on behalf of a policyholder during any given policy period

All risk insurance

The name given to a policy which covers against the loss caused by all perils except those that are specifically excluded by the terms of the policy.

Allied lines

Types of insurance associated with property insurance, which may include earthquake, sprinkler leakage, and income and extra expense coverage.

Application

A form or document used by a person seeking insurance to provide information about their operations, and to indicate type and amount of coverage desired.

Appraisal

An estimate of quantity, quality, or value. The term also refers to the report setting forth the estimate and conclusion of value.

Arbitration

If a dispute arises between the insured and the company in regard to the amount of the loss, someone approved by both parties can be appointed to consider the facts and render a judgment. The arbitrator's decision is binding and final on both parties.

Attractive nuisance

A dangerous place, condition or object, which is particularly attractive to children. In these cases the courts have frequently held that where "attractiveness" exists, the owner is under a duty to take steps to prevent injury to those that may be attracted and the owner may be held liable for failure to do so.

Audit

A survey of the policyholder's records to determine the actual exposures for which premium should be paid to the insurance company.

B

The sum of money provided in an insurance policy to be paid for certain types of loss under the terms of an insurance policy.

Binder

A temporary insurance contract pending the execution of the policy contract. It should contain a definite time limit, should be in writing, and clearly designate the company in which the risk is bound, the amount and the perils insured against, as well as the type of insurance.

Blanket coverage

Coverage under a single limit for two or more items, (e.g. building and/or contents) two or more locations, or a combination of items and/or locations.

Bodily injury liability

Insurance protection against loss arising out of the liability imposed upon the insured by law for damages because of bodily injury, sickness or disease sustained by any person or persons other than employees.

Broker

An insurance broker ordinarily is a solicitor of insurance who does not represent insurance companies in a capacity as agent but places orders for coverage with companies designated by the insured or with companies of his own choosing. The term "broker" frequently is used incorrectly to designate an agent of more than one insurance company.

Burglary

Breaking and entering into premises of another, with felonious intent, and with visible signs of forced entry. Most insurance policies specifically define burglary under their own terms, so it is wise to make sure the term "burglary" in your policy provides the coverage you need.

C

The coverage of loss or liability arising from an accident or mishap excluding certain types of loss which by law or custom are considered as falling exclusively within the scope of other types of insurance such as fire or marine. It includes, but is not limited to, employees' liability insurance, workers compensation insurance, public liability insurance, automobile liability insurance, plate glass insurance, burglary and theft insurance; also personal liability insurance, forgery, power plant and aviation insurance.

Catastrophe

A sudden and severe calamity or disaster. An event which causes a loss of an extraordinarily large amount of money.

Certificate of insurance

Document used to provide evidence of coverage to an interested third party.

Chartered Property and Casualty Underwriter (C.P.C.U.)

A designation conferred by the American Institute of Property and Liability Underwriters to one who has completed a course of instruction and passed a series of examinations.

Claim

A demand for payment under an insurance contract or bond. The estimated or actual amount of a loss.

Claim severity

The average cost of each claim.

Classification

The underwriting or rating group into which a particular risk must be placed, as determined by the risk's type of business, location and other factors. Classifying persons, property or operations as a basis for tabulating statistical experience and determining premium rates.

Coinsurance

An arrangement by which the insured, in consideration of a reduced rate agrees to carry an amount of insurance equal to a percentage of the total value of the property insured.

Commercial lines

The various kinds of insurance written for businesses.

Commercial multiple-line policy

A package policy featuring a broad range of property and liability coverages designed for businesses.

Comparative negligence

A rule used in negligence cases in some states that provides for computing both the plaintiffs and the defendant's negligence, with the plaintiffs damages being reduced by a percentage representing the degree of his or her contributing fault. If the plaintiff's negligence is found to be greater than the defendant's, the plaintiff will receive nothing and will be subject to a counter claim by the defendant.

Competitive state fund

A state fund writing insurance in competition with private insurers.

Compulsory auto liability insurance

A state law requiring motorists to obtain minimum auto liability coverages for bodily injury and property damages.

Concealment

The withholding of material facts regarding the nature of an insurance risk or loss. Withholding essential information from the insurer in negotiating an insurance contract or in making a claim.

Consequential loss

A loss not directly caused by damage to property but which arises as a result of such damage (i.e., loss of rent).

Contract

An agreement entered into by two or more parties by the terms of which one or more of the parties, for a consideration, undertakes to do or to refrain from doing some act or acts in accordance with the wishes of the other party or parties. A contract to be valid and binding must be entered into by competent parties, be bound by a consideration, possess mutuality, represent an actual meeting of minds, and cover a legal and moral act.

Contributory negligence

The lack of care on the part of the individual, which helped cause the accident.

Coverage

A guarantee against specific losses provided under the terms of an insurance policy. It is used interchangeably with the words "insurance" or "protection" and also may refer to the amount of protection afforded under an insurance policy or to the insurance contract itself.

D

That part of an insurance contract which contains information regarding the insurance risk on the basis of which the policy is issued. A statement by the applicant for insurance, usually relative to underwriting information.

Deductible

The amount of a loss, which the insured has to pay.

Depreciation

Loss in value. The difference between the replacement cost new and present value.

Direct writer

An insurance company which sells its policies through salaried employees or agents who represent it exclusively, rather than through independent local agents or insurance brokers. The insurer that contracts with the insured as distinguished from the reinsurer.

Dividend

A share of the earned surplus apportioned for distribution and reflective of the difference between the premium charged and the actual loss experience. In a mutual or participating company, it is the return to the policyholder out of the earnings of the company. In a stock or nonparticipating insurance company, it is the division of the profits among the stockholders of the company. A refund of part of the premium on a participating life insurance policy.

E

That part of an insurance premium which pays for the protection the insurance company has already given on a policy.

Employer's liability insurance

Protects an employer against the claims for damages, which arise out of the injuries to employees in the course of their work. Employer's liability insurance provides protection in cases not covered by workers' compensation insurance.

Endorsement

A provision added to a policy, to effect a change or alteration of terms or conditions; must be signed by an executive of the company and attached to and made part of the policy to be valid.

Exclusion

A provision of part of the insurance contract limiting the scope of the coverage. The causes and conditions listed in the policy, which are not covered.

Exposure

This term may refer to the state of being subject to the possibility of loss or the extent of risk as measured by payroll, receipts, area or other standards.

F

A government insurance cooperative program that makes various forms of property insurance readily available to persons who have difficulty obtaining this protection.

Fidelity bond

A form of insurance, which protects the covered employer against loss due to the dishonesty of his employees. A bond that reimburses an employer named in the bond for the amount lost due to any covered act of dishonesty by an employee. Blanket fidelity bonds embrace groups of employees.

Fiduciary

A person who occupies a position of special trust and confidence, especially handling or supervising the financial affairs or funds of another.

Financial responsibility law

A statute requiring motorists to furnish evidence of ability to pay damages, either before or after an accident.

Fire insurance

Contract prescribed by each state subject to modification by endorsements insuring against direct loss from fire, lightning and other defined causes.

Fleet policy

An insurance contract covering a number of vehicles with a single owner.

Floater policy

A policy under the terms of which protection follows movable property, covering it wherever it may be (e.g., a policy on tourist's baggage).

Flood insurance

Contract of protection for damage caused by overflowing or rising water.

J

A system used to provide insurance to individuals or businesses that fail to secure coverage in the voluntary market. Although only certain companies issue policies at one rate level and handle claims for those insured, all of the companies providing insurance in that state must bear the ultimate costs.

L

The sum or sums beyond which a liability insurance company does not protect the insured on a particular policy. The majority of policies covering liability for bodily injury have two limits: a limit of liability to any one person; and another limit, usually higher, for any single accident where more than one person is involved.

Litigation

The act of carrying on a lawsuit.

Loss

The basis for a claim of indemnity or damages under the terms of an insurance policy. Any diminution of quantity, quality or value of property.

Loss ratio

The percentage of losses to premiums.

M

Injury to the rights or property of another with a wicked or perverse intent.

Multi-peril policy

Contrary to what the name might imply, the term "multi-peril policy" does not mean a policy insuring against two or more perils. Instead, it is a policy that combines fire and casualty and marine coverages in a single contract such as the homeowner's policy.

Companies with no capital stock, owned by policyholders. The earnings of the company over and above the payments of the losses and operating expenses and reserves are the property of the policyholders.

N

Named perils or hazards, policies name the specific perils or hazards the policy insures against. All risk policies do not name the perils specifically.

Negligence

Failure to do what a reasonably prudent individual would ordinarily do under the circumstances of a particular case, or doing what a prudent person would not have done. Negligence may be caused by acts of omission, commission or both.

No-fault automobile insurance

A form of insurance by which an insurance company pays for a policyholder's financial loss resulting from an automobile accident without concern for who was at fault.

Notice of loss

The conditions of the insurance policy require that any person sustaining a loss against the property insured by the policy shall forthwith (immediately) give notice to the company of such loss. This notice must precede recovery, unless waived by the insurer. The notice is required in writing, although many companies accept a notice by telephone.

O

A continued or repeated exposure to conditions, which results in a loss. Also, a policy clause stipulating all damages that arise out of the same general conditions are considered as arising from one occurrence.

P

Combination policies wherein several coverages are included in one contract.

Peril

Cause of a possible loss, such as fire, theft, explosion, etc.

Policyholder

The individual or firm in whose name an insurance policy is written. Synonymous with insured.

Pool

A group of insurance companies that have joined together for the purpose of sharing certain risks on an agreed-upon basis.

Premises

A particular location or portion thereof as stated by the policy contract

Proximate cause

The primary cause of an event, which in a natural and continuous sequence, unbroken by any new cause, produced that event, and without which that event would not have happened. For example, water sprayed from the hose of a fire fighter may damage a house, but the primary or proximate cause, of course, was the fire itself.

R

The cost of insurance per unit used as a means or base for the determination of premiums.

Rating bureau

An organization that performs insurance-related services for its members, most notably, rate making based on statistical data.

Rating territory

In some property and casualty lines rating territory refers to a geographical grouping within which insureds tend to share an exposure to similar risks. This practice helps establish rates for the territory.

Reinsurance

Acceptance by an insurer called a reinsurer, of all or part of the risk of loss of another insurer. Thus, the risk of loss is spread and a disproportionately large loss under a single policy does not fall on one company.

Rents or rental value insurance

Protection against the loss of rents resulting from an insured peril.

Replacement cost property insurance

Insurance providing the amount payable to the insured as the replacement cost of the property new, rather than the depreciated value applied to the building structures or contents.

Reserve

Funds which are set aside by an insurance company for the purpose of meeting obligations as they become due. A liability set up by an insurer for a particular purpose.

Retrospective rating

A technique which permits adjustments of the final premium for a risk based on the loss experience of the insured during the period of protection between maximum and minimum limits.

Rider

A document or form containing special provisions that are not contained in the policy contract. Such forms are to be added or attached to the policy.

Risk

A person or thing insured.

Risk Control service

An inspection or engineering service designed to help reduce a policyholder's exposure to loss.

Risk management

The practice of analyzing all noncompetitive (non-production) exposure to risk of loss (loss by fortuitous or accidental means) and taking steps to minimize those potential or real losses to levels acceptable to the organization.

S

Damaged property taken by an insurer after it has paid the claim in order to minimize its losses.

Schedule

An enumeration of various properties covered by a policy. A system for computing rates.

Self-insurance

An individual or firm's systematic provision of a fund to provide for all or part of its losses.

Short rate cancellation

The termination of an insurance policy or bond before its expiration either by the insured or the company. The notice necessary before such cancellation becomes effective is almost always stated in the insurance contract.

Standard provisions

Those clauses that certain state codes prescribe as being inserted in contracts of insurance; Contract provisions in general used by insurers, adopted by a group of insurers, approved by a state insurance department, or required by statute, either literally, in substance, or in a form more favorable to the insured.

Stock company

A company owned by a number of investors or stockholders.

Subrogation

The right of the insurance company to recover from a third party the amount paid under the policy.

Surety bond

An instrument providing for monetary compensation should there be a failure to perform any specific acts within a stated period.

Suretyship

All forms of obligations to pay the debt or default of another. The function of being a surety.

Surplus line

Business which would otherwise be subject to regulation as to rates or coverage, placed in non-admitted markets on an unregulated basis in accordance with the Surplus or Excess Line provisions of state insurance laws.

Syndicate

Group of companies or other underwriters who join together to insure a certain property which may be of such value, or of such high hazard, or so expensive to underwrite that it can be done more efficiently on a cooperative basis.

U

The individual whose duty it is to determine the acceptability of insurance risks; a person whose duty it is to select risks and determine the amounts and terms by which the insurance company will accept the risks.

Underwriting profit

The profit or loss an insurance company experiences after deducting incurred losses and business expenses from earned premiums. This amount excludes investment income and is determined before the provision of federal income tax.

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